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Inferior outcomes of liver transplantation for hepatocellular carcinoma during early-COVID-19 pandemic in the united States

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World Journal of Hepatology 2023年第4期15卷 554-563页

作者： Inkyu S Lee Kenji Okumura Ryosuke Misawa Hiroshi Sogawa Gregory Veillette Devon John Thomas Diflo Seigo Nishida Abhay Dhand Department of Surgery Westchester Medical CenterValhallaNY 10595United States Department of Medicine Westchester Medical CenterValhallaNY 10595United States

BACKGROUND Early in the coronavirus disease 2019(COVID-19)pandemic,there was a significant impact on routine medical care in the united States,including in fields of transplantation and *** To analyze the impact and outcomes of early COVID-19 pandemic on liver transplantation(LT)for hepatocellular carcinoma(HCC)in the united *** WHO declared COVID-19 as a pandemic on March 11,*** retrospectively analyzed data from the united network for organ sharing(UNOS)database regarding adult LT with confirmed HCC on explant in 2019 and *** defined pre-COVID period from March 11 to September 11,2019,and early-COVID period as from March 11 to September 11,*** Overall,23.5%fewer LT for HCC were performed during the COVID period(518 vs 675,P<0.05).This decrease was most pronounced in the months of March-April 2020 with a rebound in numbers seen from May-July *** LT recipients for HCC,concurrent diagnosis of non-alcoholic steatohepatitis significantly increased(23 vs 16%)and alcoholic liver disease(ALD)significantly decreased(18 vs 22%)during the COVID *** age,gender,BMI,and MELD score were statistically similar between two groups,while waiting list time decreased during the COVID period(279 days vs 300 days,P=0.041).Among pathological characteristics of HCC,vascular invasion was more prominent during COVID period(P<0.01),while other features were the *** the donor age and other characteristics remained same,the distance between donor and recipient hospitals was significantly increased(P<0.01)and donor risk index was significantly higher(1.68 vs 1.59,P<0.01)during COVID *** outcomes,90-day overall and graft survival were the same,but 180-day overall and graft were significantly inferior during COVID period(94.7 vs 97.0%,P=0.048).On multivariable Coxhazard regression analysis,COVID period emerged as a significant risk factor of post-transplant mortality(Hazard ratio 1.85;95%CI:1.28-2.68,P=0.001).CONCLUSION Durin

关键词： Liver transplantation Hepatocellular carcinoma COVID-19 Mortality Graft failure united network for organ sharing database

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